Provider Demographics
NPI:1598804965
Name:VINTON, KRISTINE LOUISE (LICSW)
Entity Type:Individual
Prefix:MS
First Name:KRISTINE
Middle Name:LOUISE
Last Name:VINTON
Suffix:
Gender:F
Credentials:LICSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1010 MASSACHUSETTS AVENUE
Mailing Address - Street 2:
Mailing Address - City:BOSTON
Mailing Address - State:MA
Mailing Address - Zip Code:02118
Mailing Address - Country:US
Mailing Address - Phone:617-534-2398
Mailing Address - Fax:617-534-4688
Practice Address - Street 1:205 TOWNSEND ST
Practice Address - Street 2:BOSTON LATIN ACADEMY
Practice Address - City:BOSTON
Practice Address - State:MA
Practice Address - Zip Code:02121
Practice Address - Country:US
Practice Address - Phone:617-534-9952
Practice Address - Fax:617-534-9512
Is Sole Proprietor?:No
Enumeration Date:2007-02-05
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MALICSW1135451041S0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041S0200XBehavioral Health & Social Service ProvidersSocial WorkerSchool